Morbidity of Microsurgical Breast Reconstruction in Patients with Comorbid Conditions

Abstract

Despite having significantly higher complications in the form of delayed donor-site wound healing in active smokers and higher total flap loss in obese patients, the overall complication rates compared with other reconstructive procedures are low. Microsurgical reconstruction with DIEP and muscle-sparing TRAM flaps is associated with low complication rates, excellent aesthetic outcome, and high patient satisfaction, even in patients with known risk factors.

Patient determinants as independent risk factors for postoperative complications of breast reconstruction

“…It is also well established that smoking has a negative influence on free flap breast reconstruction (6,45,(55)(56)(57)(58)(59), although some studies have failed to establish this relationship (4,(60)(61)(62). The same seems to be true for implant-based reconstructions (16,35,44,(63)(64)(65), but not all studies can confirm these findings (52).…”

“…The same seems to be true for implant-based reconstructions (16,35,44,(63)(64)(65), but not all studies can confirm these findings (52). Many studies show no relationship between age and risk for complications (45,57,(60)(61)(62)(66)(67)(68)(69)(70)(71), while other studies show that elderly patients have more risk (44,53,63). Diabetes has been associated with postoperative complications after autologous reconstruction, but the results after implantbased breast reconstruction are more conflicting (52,(72)(73)(74)(75).…”

“…Significant independent risk factors have been previously identified, both in plastic surgery and in other specialities (40,44,45,50,72,(83)(84)(85)(86)(87)(88)(89)(90)(91)(92)(93). However, the advantage of the present study is the evaluation of four different reconstruction methods with the same criteria for complications.…”

“…Several studies have examined the relationship between several patient characteristics (other than adjuvant therapy) and complications (2,6,(42)(43)(44)(45), but there was variation in the factors studied, and inconclusive results.…”

De-Mythifying Breast Reconstruction: A Review of Common Misconceptions about Breast Reconstruction

“…In a prospective study of 624 free flaps, smokers had a 9% risk of flap complications and a 12% risk of donor site complications, and often problems with wound healing. 33 In Chang and colleagues, 34 the largest multicenter level III study (n ¼ 718), smokers had a significantly higher incidence of mastectomy flap necrosis than nonsmokers (18.9% vs 9.0%; p ¼ 0.005). 34 Smokers also had an increased risk of donor-site complications, including abdominal flap necrosis, than former smokers (25.6% vs 10.0%; p ¼ 0.001) or nonsmokers (14.2%; p ¼ 0.007).…”